Thailand Volunteer Deployment Form

Thailand Volunteer Deployment Form

Thank you for your interest in serving with PCCR in Thailand!
Section 1: Your Information

Please enter your information exactly as it appears on your passport. Please double check and verify that all the information is correct. PCCR is not responsible for errors on this form. Your information will be kept private.
Name*

First NameMiddle NameLast Name
Address*

Street Address

If your address follows a different format, please type it in this field

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Date of Birth*

MonthDayYear
Date
Identification

We issue all our volunteers official PCCR ID cards. For this purpose, you need to have someone else take a clear passport-type photo of yourself, head and shoulders, against a white or off-white background. A phone camera is okay, but selfies do not work for this.
ID Photo*

Cancelof
Driver License*

Please upload a photo of your driver's license here:
Cancelof
Passport ID Number*
Passport Expiration Date*

MonthDayYear
Date
Passport *

Please upload a photo of your passport here:
Cancelof
Section 2: References & Point of Contact

We need at least three separate points of contact for you in case of accidents and emergencies on the field. At least two of them need to be able to serve as references if there are any questions.
Who should we reach out to in case of accidents or emergencies?*

Parent/Legal GuardianSpouseSiblingPastorOther
Parent - Legal Guardian *

First NameLast Name
Parent's Phone Number*
Please enter a valid phone number.
Can your parent/legal guardian serve as a reference?

Yes
Spouse*

First NameLast Name
Spouse's Phone Number*
Please enter a valid phone number.
Can your spouse serve as a reference?

Yes
Sibling*

First NameLast Name
Sibling's Phone Number*
Please enter a valid phone number.
Can your sibling serve as a reference?

Yes
Pastor*

First NameLast Name
Pastor's Phone Number*
Please enter a valid phone number.
Can your pastor serve as a reference?

Yes
Other/Friend*

First NameLast Name
Other/Friend's Phone Number*
Please enter a valid phone number.
What is your connection to this person? *
Can your friend serve as a reference?

Yes
Section 3: Skills and Experience

Experience, skills and other information
Have you ever served with PCCR before?

YesNo
Please briefly describe your experience with PCCR.*
Which option best describes your travel experience?*

I have never traveled by plane or internationallyI have traveled to Mexico/Canada, but never overseasI have traveled overseas once or twiceI have traveled internationally extensively
Please give us a brief description of your prior travel experience(s).*
Do you have skills that you feel are applicable to the field you'd like to serve in? Check all that apply.

EMTRNDoctorParamedicTranslatorTeacherOther
Have you served with other international organizations?*

YesNo
Briefly describe the organization, your position and work while there.*
Tell us more about yourself... *
Section 4: Health Information

Please fill out this section as completely and honestly as possible.
We are asking for this information because some of the fields we work in have very harsh weather and living conditions. We need this information to do our best to keep you safe and healthy. We will not share this information with anyone outside of our organization unless needed for your health and safety in case of an emergency on the field.

You need to be aware that the travel and living conditions can be harsh and intense. You are not guaranteed a good night of sleep regularly. You will most likely see devastation and hardship. If you are not emotionally strong, this will be hard for you.

You need to be aware that most places will not have medical services like the United States. Often, there are no urgent care clinics. Hospital visits are reserved for life-threatening injuries.
Do you take any medication?*

YesNo
Please explain which medication(s) you take and why.*
Do you have any special health or diet needs or restrictions?*

YesNo
Please explain your restrictions and/or other needs.*
Are you physically strong and able to work easily?*

YesNo
Please explain your limitations. *
Do you struggle to cope when the weather is very hot or cold?*

YesNo
Please explain.*
Is there anything else that we should know about your health or any other concerns that you have?
Section 5: General Character Profile

Please as accurate and honest as possible.
Are you a born-again Christian?*

YesNo
Year of spiritual birth, if unsure write unsure*
Do you have emotional issues that keep you from working with or getting along well with other people?

YesNo
If yes, please explain your answer
Do you interact well with other people?*

YesNo
Please explain your answer.
Do you enjoy being around other people?*

YesNo
Please explain your answer.
How important is occasional alone time to you? *

1

2

3

4

5

1 is Not at all, 5 is Extremely Important
Are you good at taking care of yourself and others?*

YesNo
Please explain your answer
Guys and girls will be traveling and living at the PCCR base together. Can we trust you to conduct yourself with integrity, purity and appropriate behavior at all times?*

YesNo
What is your marital status?*

SingleDating/EngagedMarriedWidow(er)
Is your partner planning to travel with you?*

YesNo
Section 6: Travel Costs & Planning

If you get the opportunity to serve with us, the cost of your trip will be the ticket and any personal expenses incurred on the field. If you serve less than three months with us, you will be responsible for your own international phone service and any personal purchases, including paying for food when you go to eat out, outside of PCCR. We will cover the food and lodging.
How did you hear about this opportunity?*
Vision: Briefly describe what you would like to accomplish by going on this trip. *
When would you be available to serve?*
Generally, a minimum of 4 weeks + travel time is required.
How long can you commit to serve?*

1 month3 months6 monthsOther
Is there anything else that you think we should know about yourself and/or your reason for volunteering in this field?
Generally, all volunteers are added to our mailing list, including newsletters and emails. If you do not wish to receive them, please check the box below.

I do not wish to receive newsletters or emails
PCCR operates in some very intense places and situations. It is vital for your safety and the safety of your team that you obey and follow all rules and directives at all times from your team leader or Project Coordinator. By signing below you agree to abide by all policies, practices and instructions of PCCR whether written or verbal.
Signature*

Clear
Please verify that you are human*
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Thailand Volunteer Deployment Form

Section 1: Your Information

Identification

Section 2: References & Point of Contact

Section 3: Skills and Experience

Section 4: Health Information

Section 5: General Character Profile

Section 6: Travel Costs & Planning